"Have you tried turning it off and on again?" has become a bit of a joke when dealing with problems with electronic equipment, but more often than not it does work. Now, Canadian doctors and researchers have found that rebooting the immune system essentially cures early, aggressive MS. In clinical trials, the treatment was shown to suppress brain inflammation, prevent relapses, halt disease progression and even reverse some symptoms like vision loss and muscle weakness.
Multiple sclerosis (MS) is estimated to affect around 2.3 million people globally and occurs when the immune system mistakenly attacks the central nervous system. Symptoms range from extreme fatigue to blurred vision to partial or complete paralysis, which often flare up as a result of inflammation in the brain, in recurring episodes called relapses.
In this treatment, called immunoablation and autologous hematopoietic stem cell transplantation (IAHSCT), doctors deliberately target the diseased immune system, killing it off with high dosage chemotherapy drugs. Hematopoietic stem cells, previously collected from the patient's blood, are then transplanted back into their body. These stem cells will form a new immune system that has no "memory" of the attack on the nervous system.
A clinical trial of the treatment, conducted through The Ottawa Hospital and the University of Ottawa, showed very promising results. 24 patients suffering from aggressive MS were treated and then followed for between four and 13 years.
Post-treatment, none of them experienced a relapse – down from a yearly average of 1.2 relapses per participant prior to treatment – and on 327 MRI scans post-treatment, not a single brain lesion was detected (where 188 had been found in 48 scans beforehand). MS-specific drugs were no longer needed to control the disease, with progression of the disease halting completely for 70 percent of the participants. And 40 percent experienced reversal of symptoms such as impairments to vision, muscles and balance.
"Although this trial was relatively small, it was intensive, with the
longest prospective follow-up of any such treatment group to date, and
that is what makes the results so convincing," noted Dr. Mark S Freedman of The Ottawa Hospital and the University of Ottawa.
Of course, completely shutting down a patient's immune system poses significant risks: one participant died of liver failure as a result of the treatment, while a second spent time in intensive care with related complications. All participants developed fevers, often associated with infections.
"It is important to note that this therapy can have serious side effects and risks, and would only be appropriate for a small proportion of people with very active MS," says Dr. Harold Atkins, who led the trial. "People with MS who have had significant disability for a long time would likely not benefit."
"A variation of this procedure has been used to treat leukemia for decades, but its use for auto-immune diseases is relatively new," says Atkins. The team hopes the trial's positive results will encourage further research, and lead to better treatment options in the future.
"Before my transplant I was unable to walk or work and was living in assisted care at The Ottawa Hospital Rehabilitation Centre," says Jennifer Molson, one of the trial's participants. She was diagnosed with MS in 1996 at the age of 21, and received the stem cell transplant in 2002. "Now I am able to walk independently, live in my own home and work full time. I was also able to get married, walk down the aisle with my Dad and dance with my husband. I've even gone downhill skiing. Thanks to this research I have been given a second chance at life."
The results were published in the journal The Lancet, and are discussed in the video below.
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